Be ready to signify the cause of the croup under ICD-10.

Coding for children with croup has always been fairly straightforward because ICD-9 offers just one diagnosis code for the condition, which is 464.4. Fortunately, when ICD-10 takes effect next year, you’ll get the benefit of a one-to-one conversion.

Croup results from inflammation around the patient’s larynx and windpipe, causing a bark-like cough in pediatric patients. Currently, you report 464.4 (Croup) for this diagnosis, but

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Question: My physician noted that he inserted a central line through the right femoral vein and a triple lumen catheter was advanced over the wires into the right femoral vein. To code 36556 (patient is over 5 years old) the line has to terminate in the subclavian, brachiocephalic, iliac vein; the superior or inferior vena cava; or the right atrium. What is the code if it didn’t terminate in any of the above areas?
SuperCoder.com Member

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You have a little more time to verify that providers are eligible to order Medicare tests.

CMS has announced that “Due to technical issues, implementation of the Phase 2 ordering and referring denial edits is being delayed.”

This announcement came not long before the planned May 1 implementation, which would have triggered denials for certain claims, including Part B claims from labs and imaging centers, if the ordering provider was not appropriately listed or was not eligible to order the service. A new implementation date has not been announced as of publication time.

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Add 2 new Q codes to your system to keep your coding compliant.

The July 2013 HCPCS update has coding changes in store for both liposomal doxorubicin HCl and zoledronic acid. Pay attention both to the new codes available and

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Descriptor won’t even change from 723.1 to M54.2.

Chronic neck pain is one of the most common complaints among patients who see a pain management specialist, and a simple one to code from a diagnosis standpoint. You report 723.1 (Cervicalgia).

Your choice will remain simple in ICD-10, when you’ll make an easy switch to M54.2 (Cervicalgia). Diagnosis M54.2 falls under the category “Other Dorsopathies; Dorsalgia.” Note that M54.2 does not apply to cervicalgia due to intervertebral cervical disc disorder. For those situations, ICD-10 directs you to the M50 (Cervical disc disorders) code family.

Coding tip:

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Question: The physician administered trigger point injections to fingers 2-5 on both the patient’s hands. He coded the procedure as 20605 x 8, but I don’t think that’s correct. What should we report?
Massachusetts Subscriber

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Many MUEs make sense, but for those that don’t, you can fight back.
By now, most practices are familiar with Medicare’s medically unlikely edits (MUEs), which CMS instituted to prevent overpayments caused by gross billing errors. On April 1, CMS updated the MUE listing, and some of your favorite codes may now be limited by the bundles. When you scour your unpaid claims, make sure you are watching for MUE denials to ensure that you’re getting paid when appropriate but that you fight back when your claims are inappropriately denied.”

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Watch for retroactive pay raises, if you self-attest.
Getting a payment increase from Medicaid sounds quite appealing to most practices, and it can be a reality for some primary care providers — but don’t forget to do your part to ensure that you’ll see a rise in Medicaid payments for E/M and vaccine services this year. Follow a few quick steps to confirm that you’ll get the raise.

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Nerve conduction study (NCS) coding saw a major overhaul for 2013, requiring you to swap counting nerves for counting tests. To ensure your choice of units doesn’t run afoul of the new rules, check out the just released March 2013 CPT® Assistant. You’ll get the nuts and bolts of the procedures 95907-95913 describe, as well as clarification of what counts as a single study. And don’t miss the six different coding scenarios that help you see the rules in action.

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Highlight this character for the radioactive isotope.

When you prepare to report a radiology oncology procedure, you need to pay particular attention to characters 3-6, as these specify the radiation, treatment type, modality, and radioactive isotope.

Review Your Seven Digit PCS Structure

When reporting any ICD-10-PCS code, you have seven characters. You can break them down as follows:

Character 1 Section
Character 2 Body System
Character 3 Root Type
Character 4 Treatment Site
Character 5 Modality Qualifier
Character 6 Isotope
Character 7 Qualifier

For radiation oncology services, you can focus on the first character of “D,” because “D” stands for “radiation oncology.”

Specifically, the main focus of your character selection should be the following:

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